Biliary Popcorn 2 Flashcards
Condition?
- CBD is MC location
- Bacteria infects bile
- Pus under pressure –> surgical emergency
- Fever / RUQ p / Jaundice
- Leuks >20,000
- Cholestasis: ↑conj bil, ↑alk phos
- Absent urobil on UA
Tx?
Ascending/Acute Cholangitis
Tx:
- Admit & consult gastroent emergently!
- Broad abx: piper-taco, Cef+Metro, Cipro+Metro
- ERCP w/ sphincterotomy & stone extraction, stent placement
- Follow w/ CCY
Condition?
- Appears acutely ill
- Diaphoretic
- +fever, tachy, hypotension
- Icterus
- RUQ/Epi & guarding
- AMS**
Ascending/Acute Cholangitis
Charcot’s Triad?
Which condition?
Ascending/Acute Cholangitis
- Fever/Chills
- RUQ pain
- Jaundice
Reynolds Pentad?
Which condition?
Ascending/Acute Cholangitis
Charcot’s Triad:
- Fever/Chills
- RUQ pain
- Jaundice
+ Reynold’s
- Hypotension
- AMS
- Temporary RUQ pain episodes
- No fever
- No leukocytosis
- No jaundice
Biliary Colic
- Persistent RUQ pain
- Fever
- Leukocytosis
- No jaundice
Acute Cholecystitis
- RUQ/epigastric pain
- Jaundice
- No fever
- No leukocytosis
Choledocholithiasis
- RUQ/epigastric pain
- Jaundice
- Fever
- Leukocytosis
Ascending Cholangitis
31 y/o female
- RUQ pain x 8 hours
- Fever
- Hx of 4 – 5 similar episodes
- Leukocytosis
- No obstruction: bilirubin normal
Acute Cholecystitis (sxs >6 hrs)
Which condition?
- Females 35-60
- Autoimmune
- –> cirrhosis / liver failure
Primary Biliary Cirrhosis (PBC)
B=Breasts
- Fatigue
- Pruritis à followed by jaundice
- Arthritis
- RUQ pain
- Hyperpigmentation of skin
- Xanthomas
- Hepatomegaly
- CREST sxs – limited scleroderma (Calcinosis under skin, Raynaud’s, Esophageal dysfunction, Sclerodactyly, Telangectasias)
PBC
AMA is hallmark
ANA
Livery biopsy
PBC (primary biliary cirrhosis)
Tx for PBC?
Urso
DEXA (bone density)
Condition?
- MEN
- 75% w/ Ulcerative Colitis
- Inflammation/fibrosis of med-large ducts
- 10-12 yr survival after diagnosed
Tx?
Primary Sclerosing Cholangitis (PSC)
S= scrotum
Condition?
- Steatorrhea
- Pruritis AFTER jaundice
- Fatigue
- P-ANCA, ASMA, ANA, IgM
- ERCP, MRCP
- Don’t do liver biopsy…
PSC
(Primary Sclerosing Cholangitis)
Complications of PSC?
- Cirrhosis
- Osteoporosis
- Biliary stricture
- Cholangitis**
- Cholangiocarcinoma**
- Gallbladder cancer**
- Colon cancer (if IBD – Ulcerative Colitis is present)**
Tx for PSC?
- DEXA
- ERCP
- Liver transplant (for advanced dz)
Condition?
- Deficiency in enzyme for glucuronidation of bilirubin in liver (conjugation)
- Homozygous
- Suspect in pts w/ unconjugated hyperbilirubinemia in the absence of hemolysis
- NORMAL labs
Gilbert’s Syndrome
Condition?
- Majority of biliary tract cancers (>50%)
- RF: cholelithiasis, gallbladder polyps >1cm, Salmonella infection
- Sxs of malignancy (anorexia / weight loss)
GB cancers
Condition?
- Adenocarcinoma of bile ducts (intra/extra hepatic)
- Assoc w/ PSC & Choledochal cysts
- ***Jaundice+++
- Vague upper abd pain
- Anorexia
- weight loss
Cholangiocarcinoma
Condition?
- Labs: cholestasis (obstructive pattern)
- ↑conjugated bilirubin & alk phos
- ↑ Tumor marker CA 19-9
Cholangiocarcinoma
Condition?
- where CBD & pancreatic duct come together
- RARE
- Assoc w/ familial adenomatous polyposis (FAP) & Hereditary Non-Polyposis Colon Cancer (HNPCC)
Ampullary Cancer
Condition?
- Obstructive jaundice (MC)
- Occult GIB à Microcytic Anemia
- Abdominal pain
- Microcytic Anemia
Ampullary Cancer
